Home birth or hospital?

[ElsieMae13]

I’m 30+ weeks, and seriously contemplating home birth. This is my 1st baby but uncomplicated so far, and my midwife has advised me not to think about this. We’re also 40 minutes from my nearest hospital. Her main issue seems to be that I fall between catchment areas for local hospitals though; my doctors surgery is covered by one hospital but my home address another, so neither hospital want to send out midwives! I’m keen for a home birth because my mum delivered me (baby 1) in under an hour from contractions being 15 min apart and my sister (baby 2) in 40 minutes. I’m taking after her in all other ways with this pregnancy and have a very similar build, so am nervous I may end up delivering on the ring road if I aim for a hospital birth! Should I insist that they at least let me explore the option or should I just accept a hospital birth? Did anyone else take a home birth against advice?

We live semi rurally and are opting for a homebirth for our first dc. The idea of going backwards and forwards to our nearest city hospital is completely unappealing and sound s like a sure fire way to slow progress!

My atttitude is that at home I get 2:1 care from the midwives, something you wouldn't get in hospital, my dm and dh are on board and will be able to support me in all manner of practicalities and should the need for a transfer arise, the midwives are likely to pick up on it far sooner than when it becomes an immediate emergency.

I am not naive and know that no birth is entirely predictable and that a low risk pregnancy doesn't always equate to a straight forward delivery. However I feel I've made an informed decision and will continue to press this upon my local midwife team.

I hope whichever you decide to do, you're able to relax at little and not fret about birthing in transit!

My mum had no complications, four babies and quick births. I had a totally straightforward pregnancy. I tried to give birth with no 1 in a midwife unit. DS1 got stuck and I was then in an ambulance for 45 mins to nearest hospital with only gas and air. It was horrific. Had em CS.

My second shot out the usual way. Was in hosp but could have easily had a home birth.

From my experience (mine and that of many I know) it is the first birth that can be the trickiest. I’d go to the hosp with no 1 then have a Home birth for any subsequent babies.

We have a low maternal death rate for a reason- because we have hospitals.

Reading the above link I personally wouldn’t risk it for a first baby.

My low risk pregnancy turned into a high risk one as soon as my waters went so I wouldn’t of had the option to stay at home anyway.

Hmm. I had a homebirth while approx 40 mins from hospital - but that was for my second. My first was also a homebirth, but we lived about 10 minutes from the hospital.
Generally I am all for homebirth, but in your case OP I’d definitely think hard and make sure you have a balanced view - risks as well as benefits. The thing with birth is that you have every chance of everything going smoothly and being absolutely fine - but you can’t really know that for sure until you’ve done it. That still stands if it’s your second, third, twentieth baby - but the first time really is a total unknown. You don’t know how you’ll react, physically or mentally to labour. You don’t know if you have a cephalo-pelvic disproportion (hip size isn’t a good indicator of pelvic canal size), or if you’re a bleeder and prone to PPH, or anything tbh. And you probably aren’t, you’re probably fine, but if you are, then you’re a long way from hospital. And don’t assume you’ll be top priority for an ambulance even if something were to go wrong. I have personally witnessed a woman at a homebirth with a retained placenta wait over an hour for an ambulance to arrive to transfer her to hospital, despite being called in by a HCP as a category 1 999 call (so highest risk/risk to life). She, and we, were very lucky that she didn’t start actively bleeding - she could easily have bled out and there would have been bugger all anyone could do about it.
The flip side is that the vast majority of women are perfectly capable of giving birth with no or minimal intervention; there’s no doubt that the care you get at a homebirth is much more attentive than in hospital, and as someone else said, if things do go wrong, they’re likely to go wrong slowly, so plenty of time for a change of plan if necessary. I also found my midwife supremely unhelpful and unsupportive when I was attempting to plan a homebirth with my first baby (which in the event was all perfectly fine and went totally smoothly. But if you choose to homebirth, the midwives have a legal requirement to come and provide care - they cannot refuse you care, even if you’re doing it against medical advice. And it’s not for you to sort out the cross-county/hospital issue - they should be able to deal with that. You’re well within your rights to decide that you want to try a homebirth and ask that they organise your care accordingly. But make sure you do your own research, have a full and balanced picture, and keep an open mind - don’t set your heart on a specific birth. Everything can change! Very best of luck OP, hope it all works out for you whatever you decide

A home birth is your choice and they have to support you. It's NHS policy and they don't get to do otherwise. I had my first at home and now pregnant with my 2nd and planning another home birth. It was lovely and relaxing. Frankly, I couldn't have imagined being in hospital. I had to be in hospital a week later with my dd due to weight gain issues as we had a horrible time bf and we were on the maternity ward. It was awful and stressful with alarms going off at all hours of the night and midwives busting in and flipping the lights on at 3am. I couldn't have imagined actually giving birth there. I think I probably avoided a lot of unnecessary complications by being in my own space where I could be relaxed and comfortable.

I think if you feel happier and safer and more comfortable in hospital, then that's the place you should be. But if you feel happier and safer and more comfortable at home, then that's the best place for you. But there's no reason not to be at home if that's what you want just because it's your first. 40 minutes by car from hospital is considerably shorter by ambulance and if you needed any emergency care in hospital that couldn't be done at home, you would need to wait 20-30 minutes anyway. So it's no faster to get a c-section from the ward. You'll have plenty of time. I'm about 25 minutes from hospital myself and it's never been an issue.

If it's what you want, then insist on it. They can't say no.

I am planning a homebirth for my first baby. However I think a transfer time of 40mins would give me pause. Our nearest maternity unit is 15 mins drive, prob less in an ambulance. Although I think your concern re transfer if you do go for hospital is also worth thinking about. Tricky. The birthplace study indicates that 45% of first time home births end up transferring to hospital, as I understand it that’s transfer mid labour. The thing that gives me heeby jeebies is cord prolapse (no idea why my brain has focused in on that but there you go) but even in a hospital situation there will still be minutes before baby is out. In my case I’ve been reassured by amount of time to get us there would be not very much more than amount of time to prep for surgery. You would be a bit further away. Oth, you’d hopefully be labouring with midwives on hand rather than unaccompanied transfer.

Your midwife is not being truthful about your access to homebirth however. I would check on your trust website about choices re place of birth and you may be able to contact homebirth team direct (am assuming all areas have a team, I may be mistaken!)

I had my first in the hospital and 2 nd 3 at home. It was amazing being in my own environment. So much less clinical and invasive. would never give birth in a hospital again unless it was required

Don't do it for a first birth. Why take the risk? What is more important, the life and health of both your child and yourself, or your comfort and 'birth experience'?

I live a 2 min drive from my local hospital and still gave birth there (I'm in Switzerland, where they are more sensible about these things). Good job I did as DS got stuck, needed and instrumental delivery and then went straight to NICU for a week. Meanwhile, I had a haemorrage and blood transfusion.

Oh and my mum had super-fast, easy births with both myself and my sister and despite similar situations, our birth experiences could not have been more different. Assume nothing. Hope for the best, prepare for the worst.

"We have a low maternal death rate for a reason- because we have hospitals"

We have a low maternal death rate because we have good nutrition, good antenatal care, access to safe surgery, access to antibiotics and blood transfusions, access to scanning technology which can identify things like placenta praaevia during pregnancy, and access to drugs which slow down bleeding after birth.

Access to hospital care if needed is essential for a safe childbirth - but a low risk woman doesn't need to labour in one to be safe. In fact maternal outcomes are BETTER for low risk mothers in out of hospital than in hospital settings. A woman is less likely to need a blood transfusion or major surgery (with all the risks which accompany it) if she chooses an out of hospital setting for her birth.

Is 40 mins from hospital by car or by ambulance?

I've had one fairly awful hospital birth and 3 amazing home births so I'm fairly biased. But it you feel you'd be more comfortable at home then do it.

Whichever hospital you book in under will be the one to send the midwives out.

And it isn't like you can't change your mind and go into hospital

I think I'd push for more information. I had my first baby at home, and I'm incredibly glad that I did - the people I know who had their first babies in hospital mostly ended up having a pretty grim time with various scary complications.

I'd want to know more about the 40 minute transfer, and how it would be handled.

"Don't do it for a first birth. Why take the risk? What is more important, the life and health of both your child and yourself, or your comfort and 'birth experience'?"

The evidence shows that clinical outcomes for low risk first time mothers who labour at home are better than for similar women labouring in a CLU. Not just a bit better - a lot better.

The evidence shows that home births are a bit more risky for the babies of first time mothers. Not necessarily because of being outside hospital - because out of hospital births are just as safe as in hospital births if the mother is in a free-standing birth centre (where there are no neonatal or surgical facilities, and no doctors onsite) for the babies of first time mothers.

I would be wary of expecting a similar experience to your Mum. I did the exact same and it didn't work out. I was born in roughly 4 hours from start to finish, no pain relief and DM was doing the Times crossword half an hour before I arrived.

My DS managed to get stuck thanks to his giant head (inherited from his Father) and I ended up with an emcs. I couldn't have held a pen as I was shaking with every contraction and whilst I went considerably longer than DM without any pain relief, that wasn't a choice.

Apart from the fact that I'm taller, we have very similar body shapes and had very similar pregnancies.

Is there are a midwife led unit either attached to the hospital or near by as a compromise?

@dinosauratemydaffodils (enjoyed typing that one out!) I think the issue for op is partly the transfer time if she chooses to go into hospital and concern with going into active labour on the way or to-ing and fro-ing which might well have an effect in early labour. So a midwife led unit doesn’t solve that problem...unless it was half way between home and hospital, that would be ideal!

I'm a pregnant paramedic...I'm not even considering a home birth, and I am only 10-15mins from hospital.

How the ambulance service (and other areas of the NHS) "should" be functioning, and how they actually "are" functioning are two very different things.

Yes, you have an ambulance station in your town, that means nothing, these days it is the norm to pick the ambulance up from your station at the beginning of the shift and drop it back at the end, without spending any time on station during the shift, particularly in more rural stations. With hospital delays (you would need to check your local hospitals to see what they are like in your area), the ambulances will generally be centred around the hospitals (waiting with patients on board), and thus in your case 40 minute away (when one becomes available). With winter pressures hospital delays only get worse!!

It shouldn't be this way...but unfortunately it is and you need to make the best decision for your baby considering all eventualities.

Please don’t!

My dd1 was a fast, but fine birth. Until 3 hours later she stopped breathing, they suggested that the speed of both didn’t allow for all the mucus to be squeezed from her lungs. Had she been a home birth the midwives would have been gone by that point.

Since you expect a fast birth and are so far away and it is your firsts would never consider it.

What might be helpful is looking at the stats for your local ambulance services trust - I respect the inside insight from a paramedic but situations can vary enormously across the uk, and the plural of anecdote is not data. So for my local ambulance trust, the response time for category 1 calls misses the national standard of 8 mins by 5 seconds. Midwives would be expected to monitor a situation and call before it got to life threatening so it would be a category 2 emergency call, which in my area has an average response time of 19 mins (1 min above national guideline).

I don’t doubt that things are not great but I also think that it’s worth equipping yourself with information in order to make an informed decision.

Links to this clinical evidence please. Hope it's in high-quality, peer-reviewed journals too....

And as a pregnant scientist (PhD biological chemistry), I'm with the pregnant paramedic.

Im planning on a home birth next time (gave birth within an hour of getting to hospital - I sure someone told me labour lasts ages) but happy to give birth at the local birthing centre as the mess was horrific and its nice to have someone else clean up the blood that poured out for a day after

Firstly, congratulations on your pregnancy.

We opted to have DS1 at Home. At the time, we lived five minutes from the nearest hospital. A couple of things to consider are:1. Although we could have got from our living room to the maternity ward in under ten minutes, it took 40 minutes for a midwife to get to us.

1. Midwives are very cautious in home births, especially with First time mothers, and will typically transfer you to hospital if they have any concerns. In your case, this may increase he chances of a roadside birth, or, mean travelling when you are far more uncomfortable.

1. Although we delivered DS at home, there were complications and I needed urgent hospital care. We were whisked to hospital minutes after DS was born. Living so close, this wasn’t too traumatic, but a longer journey may have been.

Please don’t think i am trying to turn you off, as I really do support homebirthing, but please be aware of the reality.

Good luck, whatever you choose.

To add my voice to the ambulance situation: I called 999 for a man with a history of heart attack who was having severe chest pains.
Ambulance took 45 minutes to arrive.
So I really wouldn't rely on a fast ambulance transfer.

“DeltaG

And as a pregnant scientist (PhD biological chemistry), I'm with the pregnant paramedic”

If you’re a scientist you’ll be interested in the evidence. You don’t have to look far to find it:

www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth

According to these the safest place for a low risk woman to give birth to her first baby is in a midwife led unit not attached to a hospital.

As safe for the baby as opting for a CLU, and safer for the woman as it appears to be associated with lower rates of major surgery, blood transfusion and admission to HDU.

I spent 30 mins in active labour getting to the hospital because the nearest birth centre (5 min drive) didn't believe I was that far along. Got there and I was 9cm dilated. Baby was born within 1.5 hours so I'm glad I went as I need up needing a spinal to have my stitches done due to my body shutting down and refusing to cooperate.
Personally a hospital birth meant that if something went wrong then I was in the best place already. But a home birth would be fine. Our midwives had no problem with us having them if we wanted as they recommended them to us as we'd be more relaxed that way. If something did go wrong we'd at least be blue-lighted to the hospital and get there in 15 mins or less.

Try and go for it if that's what you want.

To add to the comments on transferring to hospital via ambulance - I was due to have DD at our lovely local MLU eight weeks ago. Things weren't progressing fast enough so I was transferred to the regional hospital (about a six minute drive) by ambulance. It was easily the most unpleasant thing about my entire labour. It was really uncomfortable being strapped down flat during my contractions and mentally the whole "OMG OMG OMG I'm being blue lighted to hospital!!" Thoughts really shook me up- I actually found it quite distressing and I'm usually not an anxious person at all, and I was only in the ambulance for less than ten minutes!

I guess what I'm saying is if you're worried about being transported by car during active labour, being in an ambulance is no better (apart from the gas and air which is ace)